The purpose of this blog is to gather information about how to support caregivers of children. The quality of the caregiving relationship in infants and young children, central to the healthy development of the growing child, can be enhanced by attention to the caregivers in the form of education and other support. This blog will become an archive for information on these issues.

Monthly Archives: July 2013

I have a wonderful new mothers’ group, and when I asked them what topics they would like to discuss – and for me to research for them – this is the first one they picked.

Working Definition: “The automatic or intentional modification of a person’s emotional state that promotes adaptive or goal-directed behavior” (Mazefsky et al, 679).

The study of ER has recently gained more attention, in part because of developments in brain science and imaging techniques. The idea of emotional regulation was earlier considered as an aspect of temperament, which is a more inclusive concept and stresses biologically based individual differences of many kinds. (I often refer to children in my practice as having “artistic temperament”.) One of the pioneers of temperament research is Jerome Kagan, who identified high reactive infants in the womb and showed that their “temperamental” characteristics, while not necessarily hindering them in their future lives, did become part of their enduring personalities.

Why do we have emotions anyway? We would all agree that emotions contribute much of what we experience of the richness in life. They also serve the more primitive function of alerting us to danger and helping us size up situations rapidly (both from inside our bodies and from the environment). Your sudden recoil when you see a darting motion on the ground near your feet is an emotion-triggered response, that from the point of evolution probably allowed humans to avoid snakes. A similar reaction is the anxiety one experiences when one has an internal proprioceptive response to losing one’s balance. These emotions allow one to prepare subsequent action to the perceived threat, in order to maintain wellbeing.

However, each individual evaluates a stimulus differently from an emotional point of view in terms of strength – ie. intensity and speed – and this will affect the characteristic emotional response the individual has. This is referred to as “emotional reactivity”. Emotional response includes components of behavior, subjective experience, and physiology.

Many treatment modalities have been used to treat emotional dysregulation. They include psychodynamic and behavioral therapies, such as CBT (cognitive behavioral therapy) and DBT (dialectical behavioral therapy). Before I get into a discussion of the therapies, I would like to give you a sense of what is going on in the brain.

YOUR BRAIN
My favorite discussions of the brain, how it develops, and how its relationship to stress and emotion are given by Dan Siegel (Siegel, 2007, 2012) and Bruce Perry (Perry & Hambrick, 2008).

1. Brain is organized hierarchically in terms of function.
2. The “lower” parts of the brain – brain stem – mediate “simple” functions that keep the body alive such as respiration, heart rate, and body temperature. The brain stem processes sensory information such as sound, light, temperature. The drive to modulate sensory input to comfortable level in individuals with heightened sensitivity to environmental influences (sensory sensitivity, resistance to change) may also influence ER.
3. The mid brain, diencephalon, mediates among other things emotion (the famous amygdala).
4. The higher cortical parts mediate language and abstract thinking.
5. Neuronal networks communicate between and among the various parts of the brain. The prefrontal cortex (PFC) is a part of the brain governing judgment; PFC is important in perspective taking. PFC/amygdala connectivity deals with gaining perspective on emotional experiences.
6. Perspective – when focus or attention is diminished by anxiety or other means, result is interruption of access to important information that may decrease arousal, so a vicious cycle can result in distorted judgment of the environment, misattribution of negative intentions to others (“they are disapproving of me” can lead to anger, shame, which can cause further misattribution of negative intentions.
7. Classical lesion studies in rodent model systems have implicated the medial pre-optic area of the hypothalamus, the ventral part of the bed nucleus of the stria terminalis, and the lateral septum as regions pivotal for regulating pup-directed maternal behavior via a limited number of key genes and hormones – estrogen, prolactin, and oxytocin . Maternal responsiveness necessarily includes hypothalamic control of both approaching distressed offspring and inhibiting competing stress responses that would interfere with providing help. Approach motivation is increased via the nucleus accumbens-ventral pallidum circuit, and avoidance is reduced by interrupting threat signals from the amygdala to the peri-aqueductal grey. Both motivations are intimately tied to the regulation of the sympathetic response system (Swain et al, pp. 116-117). Continue reading →

About

Alexandra Murray Harrison, M.D. is a Training and Supervising Analyst at the Boston Psychoanalytic Society and Institute in Adult and Child and Adolescent Psychoanalysis, an Assistant Clinical Professor of Psychiatry, Harvard Medical School at the Cambridge Health Alliance, and on the Faculty of the Infant-Parent Mental Health Post Graduate Certificate Program at University of Massachusetts Boston. Dr. Harrison has a private practice in both adult and child psychoanalysis and psychiatry. In the context of visits to orphanages in Central America and India, Dr. Harrison has developed a model for mental health professionals in developed countries to volunteer their consultation services to caregivers of children in care in developing countries in the context of a long term relationship with episodic visits and regular skype and video contact.